Individual
DR. KETHANDAPATTI CHAKRAVARTHY BALAJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 383-1016
Mailing address
PO BOX 44008, JACKSONVILLE, FL 32231-4008
(904) 383-1016
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
2010-01458
NC
208800000X
Urology Physician
Primary
ME137242
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5915217
—
NC
Enumeration date
05/19/2006
Last updated
11/14/2018
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